‘Silo’ mentality fails in treatment of addiction

Peter Fifield, manager of Behavioral Health Services at Families First of the Greater Seacoast, meets with an unidentified patient. Courtesy photo

By Karen Dandurant
news@seacoastonline.com

Posted Jul. 31, 2016 at 3:15 AM

PORTSMOUTH — Too often mental health challenges and drug or alcohol addiction are seen as separate issues, when they should be understood holistically and treated concurrently, according to experts.

Justin Looser, director of Behavioral Health Services at Portsmouth Regional Hospital, and Peter Fifield, manager of Behavioral Health Services at Families First of the Greater Seacoast, both see the need for better coordination in treatment programs.

“What we see is that about 60 percent of those we treat, people struggling with addiction, also have mental health conditions,” Looser said. “If we try to see them as separate issues, and to divide treatment in terms of services, we are likely going to fail. Many suicide cases involve substance abuse. The divide is beginning to change, but very slowly.”

Fifield is dual licensed, for both alcohol and drug counseling and as a clinical mental health counselor.

“It becomes a chicken or the egg conundrum,” Fifield said. “Which came first, the mental health condition or the substance abuse? When you look on the neurological level, we are born with a fight or flight instinct. Our emotional development begins at about age 5, and rational thinking starts at 11 and does not mature until about 25. If a problem with mental health or substance abuse occurs younger, say in an 18- or 19-year-old, at the forefront of their maturity, it is going to become a problem.”

Looser said when a person is seen in the emergency department for a substance overdose, the obvious reaction is to treat that condition. He said it doesn’t go far enough if that is all that takes place and the person is discharged.

“Yes, we need to treat the substance abuse and help the person detox,” Looser said. “That goes without saying. Alcohol is a dangerous substance that can kill a person if they try to detox on their own. With drug abuse, there are often co-morbidities like hepatitis C, abscesses and endocarditis. So we need to address the medical issues, but then we need to delve further into the mental health issues they are having.”

Fifield said that some in-patient services do not allow for co-occurring treatment programs. He said that has to change, but it will require training and funding.

“Seacoast Mental Health Center just added substance abuse counselors,” Fifield said. “It wasn’t there before because it was not fund-able. It is for them now and represents the fundamental change in the underlying philosophy that must happen.”

As an example, Fifield said, a person with post-traumatic stress disorder who uses drugs or alcohol to cope will experience increased hyper-vigilance and anxiety if his or her coping mechanism is removed.

“A person with unmanaged anxiety can turn to drinking or opiates,” Fifield said. “They think it makes them feel better, but when they try to stop, they realize the choice is no longer theirs to make.”

For those who deal with either of these problems, services are hard to come by.

“There are often long waits to get into services,” Looser said. “There has to be a better understanding of the whole person. If we lump them under the term of an addict, they are most likely still struggling with their mental well-being. There is a real condition called post-acute withdrawal syndrome. It can result in depression and anxiety that effectively takes away the patient’s coping mechanisms. Providers can be dismissive of the problem, but we can’t continue to live in silos where this is concerned. This is rarely one diagnosis or the other.”

Looser said the stigma for both issues is very real.

“Until we look further than the immediate condition, a large population is not going to be successful in either area,” Looser said.